Supported bridge position in one-stop coronary and craniocervical CT angiography: A randomized clinical trial.

Abstract

Objective: The routine patient arm position differs between coronary CT angiography (CTA) and craniocervical CTA protocols. To investigate the clinical feasibility of supported bridge position (SBP) in combined coronary and craniocervical CTA.

Methods: Prospective enrollment included patients with suspected coronary artery disease (CAD) or craniocervical artery disease (CCAD) from February 2022 to November 2022. Patients were divided into three groups: coronary or craniocervical CTA according to CAD or CCAD using standard position (group 1), combined CTA with naturally arm-down position (group 2) and SBP (group 3). Statistical analysis of objective image quality, such as noise and contrast-to-noise ratio (CNR), subjective image quality, patient position and radiation dose was performed among the three groups.

Results: Two hundred and one patients (median age, 67 years; 138 men) were included. In terms of CNR for cardiac segment, group 1 and group 3 had no statistical difference, both significantly higher than group 2 (group 1, 12.56 ± 2.05; group 2, 10.4 ± 2.43; group 3, 11.94 ± 2.22; P < 0.05). Subjective image evaluation revealed no statistically significant differences among the three groups of coronary arteries (P > 0.05). Additionally, the lateral project value of scout images at the heart level indicated a significant difference (119.48 ± 12.19, 182.34 ± 25.09, and 140.58 ± 19.68 of patients, for group 1, group 2, and group 3, respectively, P < 0.05). No statistical differences were observed in ${\mathrm{CTDI}}_{\mathrm{vol}}$ between group 1 and group 3 (cardiac scan, 15.77 [15.07-16.37] mGy vs. 14.88 [12.19-18.81] mGy; craniocervical scan, 7.85 [7.69-8.01] mGy vs. 7.88 [7.88-7.89] mGy; all P > 0.05). However, group 2 had a higher dose (19.54 [16.86-22.85] mGy and 10.87 [10.86-10.87] mGy, for cardiac and craniocervical scans, respectively).

Conclusions: In comparison with a naturally arm-down position, SBP, which aligns the humerus bones with the spinal column, can provide diagnostic image quality at routine dose level of standard position CTA.